New Ways to Manage Your Migraine

One in five women suffer migraines - but there are new ways to tackle the pain.

If you've ever rolled your eyes when a workmate has called in sick with a migraine, or a friend has asked you to pick up her child from school because she needs to lie in a darkened room, consider yourself lucky. You may have skipped the migraine gene, which affects 20% of us, and will never have to experience the pain and nausea that accompanies an attack.

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Still commonly dismissed as 'just a headache', migraines are one of those conditions that are widely misunderstood. But the millions of sufferers in the UK – most of them women (blame it on hormones) – know they're anything but. The excruciating head pain, often accompanied by flashing lights and nausea, can last up to 72 hours.

Now latest research shows that with migraines, as with so many things in life, you are either born with the susceptibility to this horrible condition – or you're not.

'Even when migraines seem to start later in life, it's likely sufferers have had the problem for much longer than they think, but it has somehow gone unrecognised,' says Dr Giles Elrington of the National Migraine Centre.

'It's now widely accepted that those who suffer from migraines have a genetic predisposition in the form of a "migraine gene". Our genes are something we cannot alter – yet. However, we can avoid the triggers that set off migraines.'

Food for thought

We've all heard talk about different foods triggering migraines – usually cheese or chocolate but, in fact, it's not the food that causes the migraine, but the migraine that causes the sufferer to seek out those foods, says Dr Elrington. 'When the migraine is still brewing, a chemical change causes us to crave certain foods, and then, when the attack follows, we mistakenly blame what we've eaten.'

So if avoiding chocolate and cheese may make no difference, what can you do?

'The main triggers are basically the things that alter the rhythm of your body,' says Dr Elrington. 'For example, when you have your period, your body is out of kilter. Equally, if something changes in your sleep-wake cycle, meal regularity, or stress load, that can upset the delicate balance keeping you migraine free.

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'Caffeine, alcohol and even changes in the weather can be triggers, so anything you can do to keep your body on an even keel, such as keeping to a strict routine – however dull that may seem – will lessen your chance of a migraine.

'And, if you know your migraines are worse around your period, a contraceptive pill can help to even out the hormonal disruption.'

But one of the biggest triggers of migraines is, ironically, our most common way of trying to control the problem.

'Taking painkillers for more than 10 days a month impairs your body's natural switch-off mechanism for migraine,' Dr Elrington explains. 'It's hard for people to accept but if you take no medication the pain will go, even if you have to wait 72 hours for it to pass. When you start treating it, you are simply pushing the pause button, and your migraine will inevitably come back.

'For a lot of people, hard though it may seem, the best way to lessen the number of attacks is to give up on medication for a while, and let migraines take their natural course. Most will find they then become less frequent – but for those who do not, getting a referral to a migraine specialist is the best hope.'

How to treat

• Preventative drugs include beta-blockers, some antidepressants, and even antiepilepsy drugs. Or, if you don't mind needles, Botox and Occipital Nerve Block injections are both options, with top-up doses every three months.

• Acupuncture – using fine needles to stimulate the release of natural painkillers – is available on the NHS. Dr Tanvir Jamil, a GP and member of the British Medical Acupuncture Society (BMAS) says: 'Expect to start with four sessions – one week apart.'

• Aspirin, ibuprofen and naproxen. 'As mentioned, never take painkillers on more than one day in three, and avoid any containing codeine or caffeine,' says Dr Elrington. He adds that the painkillers above are more effective than paracetamol, but triptans (which boost levels of the brain chemical serotonin) are even more effective.

Herbs and homeopathy

• Consider homeopathy. 'For migraines, Nat Mur is my first port of call, or Belladonna (for a pounding pain). I prescribe a 6C potency twice a day for up to five days,' says Dr Tim Robinson of the Faculty of Homeopathy. Both £5.32 for 120 tablets at www.ainsworths.com.

• Try butterbur and feverfew, says charity Migraine Action. These performed well in trials on patients experiencing around five migraine days a month. Try Life Extension Migra-Eeze (butterbur), £24 for 60 capsules, www.victoriahealth.com, or Schwabe Pharma MigraHerb (feverfew), £8.19 for 30 capsules, Holland and Barrett.

Could Botox help?

For those reluctant to take too many tablets, or who have found nothing else helps, the new injection treatments could be the answer. Botox (available on the NHS in some cases), is thought to work by blocking the pain signals to the brain. Given as a series (up to 39) of tiny injections under the skin or into the muscles of the forehead, above the ears, and into the neck and shoulders, 'the effect usually lasts about three months', says Dr Elrington. Three out of four people with chronic migraine benefit.